Just imagine: It’s the 17th of the month and the MAR’s and TAR’s have been sent to the pharmacy to be printed. In the 10 days before they come back, I have at least 100 new orders that will have to be manually written on the new orders sheets – ugh! I also have to do a double check on each and every resident’s orders just to make sure that they are correct. And how do I accomplish this? By pulling paper charts, one at a time, painstakingly going through each and every order, writing them in on the new MAR, plus calling the physician, because, hey here’s 2 orders that he didn’t sign. That in addition to documenting in the nurses notes, faxing the new order to the pharmacy, and writing the new order on the PO sheet. What a lot of paperwork!
As a former charge nurse two of my major concerns were whether or not my residents had a bowel movement and their intake for meals. Now, picture this, 5 or 6 nursing assistants in a corner, with a messy loose leaf notebook, complete with smudges. It’s 5 minutes before time to clock-out and there is no overtime allowed for charting.
Way back in the beginning, when OBRA 87 evolved, I was handed a box of forms and a large cumbersome manual. That paper version of the Minimum Data Set (MDS) assessment had little triangles next to each question. You took those little symbols and compared and calculated to determine whether or not an area would trigger. Case mix scores? It took hours to calculate, that is, if you could understand the complicated government imposed, hand written algorithms.